Physician-assisted suicide

There are certain “hot-button” issues that evoke very strong reactions.

Among them are abortion, refusal and withdrawal of life-maintaining medical treatments, same-sex rights and, their ultimate expression, same-sex marriage. In some jurisdictions, the issue of whether health care should be public or private or mixed can be very emotionally provocative.

Looking at various jurisdictions around the world, one observes different approaches to some of these hot-button issues, at times belying perceived local values, politics or religious influences.

For example, abortion is legal in France, Britain, Switzerland and Denmark, and it is also legal in countries with large populations of Roman Catholics, including Hungary, Romania and Italy. In Israel, abortion is legal, despite prohibitions against it among some Jewish groups.

In some countries, it is legal and fundable through the public health-care system. In Canada, following many challenges by the renowned (or infamous) abortion activist gynecologist, Henry Morgentaler, it is legal, even though some argue that it’s not as readily available as it should be.

Among the very hot-button issues making headlines again in Canada is physician-assisted suicide (PAS), in which a physician, under strict parameters, can prescribe, for a capable patient, medications for the sole purpose of ending the patient’s life, as long as she or he can self-administer it. This is in contrast to euthanasia, which is legal in the Netherlands and Belgium. There, a physician may legally and without prosecution end the life of a patient under strict legislated criteria. Some critics of these more permissive programs point to evidence of insufficient scrutiny and safeguards.

In Canada, the British Columbia Supreme Court ruled that Gloria Taylor, a women suffering from amyotrophic lateral sclerosis (ALS), should have the right to access PAS, as denying this right, in the Criminal Code “unjustifiably infringes the [Canadian Charter’s] equality rights.” Two months after the ruling, the federal government launched an appeal to overturn Taylor’s exemption. However, British Columbia Court of Appeal’s Justice Jo-Ann Prowse rejected that request. In a written decision, Prowse said that revoking Taylor’s exemption would cause irreparable harm to Taylor, which outweighs the federal government’s interests.

In the United States, only Oregon, Washington and Montana allow PAS. An Aug. 11, 2012, New York Times article, In Ill Doctor, A Surprise Reflection of Who Picks Assisted Suicide by Katie Hafner, Dr. Richard Wesley, a resident of Washington state who suffers from ALS, feels comfort in the knowledge that he has been given a prescription that he can take when he feels that he no longer wants to live with his illness or its symptoms, which he knows will occur in the disease’s later stages.

The lines of controversy are again drawn. On one side are those who are opposed, often on religious grounds or the fear of the impending “slippery slope” argument, despite evidence from those jurisdictions that allow PAS, where there has not been a dramatic explosion of requests. On the other side are those who want to protect and promote patient autonomy to the point of allowing a PAS decision, with the necessary safeguards to avoid abuse by patients, families or physicians.

How this will play out in Canada is still not clear, but since the Sue Rodriguez case in 1994, when her PAS request was declined through the legal process, much has changed in public opinion and the law, and PAS may become more palatable in Canadian society.

Dr. Michael Gordon is medical program director of palliative care at Baycrest. His latest book is Late-Stage Dementia, Promoting Comfort, Compassion and Care. His previous book, Moments that Matter: Cases in Ethical Eldercare, follows his memoir, Brooklyn Beginnings: A Geriatrician’s Odyssey. All can be researched at his website: http://www.drmichaelgordon.com.